Provider Demographics
NPI:1619541562
Name:SAVAGE, JACKSON DAVID (DDS, MS)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:DAVID
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N BUSINESS IH 35 STE 208
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-8063
Mailing Address - Country:US
Mailing Address - Phone:830-381-0800
Mailing Address - Fax:
Practice Address - Street 1:675 N BUSINESS IH 35 STE 208
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-8063
Practice Address - Country:US
Practice Address - Phone:830-381-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics